Critique of academic article methodology and findings

¶ … Persistent Disability Associated with Ankle Sprains: A Prospective Examination of an Athletic Population," by Gerber, et. al., published in Foot & Ankle International in 1998. The study was carried out at the United States Military Academy (West Point). This is a specialized population consisting of young, athletic men and women, but other studies have documented the prevalence of ankle sprains across populations (p. 653).

This study has significant significance to the study of podiatric practice. As the researchers point out, >40% of patients have chronic complaints about the injured ankles after treatment (p. 654). The study is timely. The results showed that we need more information about the treatment and rehabilitation of ankle sprains because careful, planned care during the first six months were "critical to achieving an acceptable long-term outcome" (p. 659, "Outcomes" section.)

The study has great utility for podiatrists because it demonstrates the need for rehabilitation of the joint even with mild sprains. This study specified their structure for rehabilitation plans ("The rehabilitation program was functionally based, allowing for the patient to progress according to his or her functional ability" p. 654) and was divided into three phases based on ongoing evaluation of each patient's ankle.

This study showed originality in that it looked at older studies first. Then the researchers refined their approaches and answered new questions. They cited studies by Jackson et. al. And others, including an earlier study at the USMA. It explained the West Point Ankle Grading System for sprains well, and generated new information regarding the previously assumed relationship between grade I sprains (usually viewed as "mild" and often excluded from ankle studies, p. 657) and long-term outcome. These researchers found that even grade I sprains could have inadequate long-term outcomes ("When comparing the two groups [grade I vs. grade II-III] at 6 months, however, few differences were seen." p. 657) They hypothesized a reason for this (ex: "Patients with grade I sprains may have self-discharged" before the planned rehabilitation was completed," p. 657).

This paper was written clearly and concisely, with good organization. They explained the preceding research, which laid the foundation for this study in the introduction, and explained their procedures clearly in the "Materials and Methods" section. They consistently specified the type of sprains the participants had, both by type (lateral vs. syndesmosis) and by severity (using the West Point ankle Grading System). They explained in detail how they did post-injury evaluations at both six weeks and six months (pp. 656 -- 657). The "Discussion" section was detailed, detailing where their findings supported previous studies and where they generated new information. They noted how the use of a specialized population may have changed their findings somewhat ("The 23% incidence of ankle sprains reported in this study is slightly higher than most reports in the literature; however, this is not surprising because the subjects in our sample participated in sports that have shown higher incidences of ankle injuries (soccer, basketball and football)." (p. 657)

The conceptual framework for this study is sound. Systematic study of the progression of the injury over time using rigorous and consistent evaluation procedures provided new information about long-term outcomes for ankle sprains. They used consistent methods both for the initial evaluation at the time of the injury and for extended follow-up evaluations. They gathered detailed information from the participants regarding both how this injury occurred and about any previous injuries to the joint involved ("Evaluation" section, p. 654). The physical exam was detailed and included stability and range of motion testing, strength testing, evaluation of amount of swelling, palpation, evaluation of ligaments and rotation stress test. Injuries were rated using the chosen rating scale systematically.

The methodology was clearly explained and included detailed initial evaluation, three-phase rehabilitation, and follow-up examinations at both six weeks and six months. This study could easily be replicated In other populations.